Nursing Care in the Postpartum Period
Anuradha Perera (B.Sc.N)Special
05/08/23
Postdelivery Assessment
• Greatest risk for postpartum complications is during the first 24 hours after delivery
• Identification of potential problems; immediate intervention; reassessment
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• Assessment includes:– Condition of uterus– Amount of bleeding– Bladder & voiding– Vital Signs– Perineum
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• Fundus = Palpated to assess firm & well contracted
• Bleeding = Assess drainage on pad• Pulse & Bp = Assess cardiovascular
function• Perineum = Assess for signs of hematoma,
lacerations, & edema
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• Assessments are q 15 minutes for the first hour post delivery
• Temperature is taken at the end of first hour
• Transferred to Postpartum Unit when stable
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Admission to Postpartum Unit
• Report between L&D Nurse & PP Nurse• Preparations made for receiving the Mother
such as:– Room Ready– IV Pole– Admission Assessment– Vital Signs Equipment
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Assessment
• Assessment is immediately upon arrival to the PP Unit– Complete Assessment– BUBBLE HE & VS included
• Reassessment q Hour x 4 Hours– Uterus, Lochia, Bladder, Bp & Pulse– Abnormal Findings
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Vital Signs
• Elevated Temperature– Normal finding for first 24 hours– Sign of Dehydration– Sign of Infection
• Bradycardia– Normal Finding
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• Tachycardia– Infection– Hemorrhage– Pain– Anxiety
• Lowered Blood Pressure– Orthostatic Hypotension– Shock
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• Elevated Blood Pressure– Pregnancy-induced Hypertension
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Breasts
• Soft, firm, can be lumpy• Secretion of Colostrum• Engorgement• Assessment of:
– Breasts– Nipples
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Uterus• Process of Involution• Height
– First Day = at Umbilicus– Decreases 1 FB per Day
• Consistency– Firm, Round, Smooth; Not “Boggy”
• Location– Midline
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Bladder
• Often times will be catheterized in L&D post delivery
• Assess for Bladder Distention:– Uterine Atony– UTI
• Recatheterize in 6 hours if not voided • Measure Urine Output
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Bowel
• Assessment for Bowel Sounds• Complaints of Gas Pains• Usually has Stool 2-3 days post delivery• May need medication for gas pains,
laxatives, stool softeners, enemas
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Lochia
• Amount– Estimate of Drainage– Number of Pads
• Color– Rubra– Serosa– Alba
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Episiotomy
• Assessment for:– Hematomas– Ecchymosis– Edema– Erythema– Intact Suture Line– Signs of Infection
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Homan’s Sign
• Assessment for Thrombophlebitis– Swelling– Reddness– Warmth– Pain
• Unilateral Findings• C/S Mother at Higher Risk
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Emotional Status
• Can have Mood Swings
• Observing Bonding Behavior & Ability to give Infant Care– Rubin’s Phases– En face– Engrossment
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Patient Post Epidural
• Assessment of Lower Extremities for:– Sensation– Movement
• Remains on Bedrest
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Post C/S
• Additional Assessment:– Incision– Fluid Intake– Bladder & Bowel– Ambulation/Orthostatic Hypotention– Thrombophlebitis
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Documentation of Findings
• Assessment Checklist Form• Graphic Sheet• Narrative Notes
– Admission– Daily
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Nursing Diagnoses
• Throughout the chapter
• NCP
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Interventions
• Prevention of Complications• Reduce Discomfort• ADL
– Nutrition– Rest & Sleep– Ambulation– Bathing– Kegel Exercises
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Predischarge
• Rubella Vaccine– Titer– Hypersensitivity to eggs– Administration of Vaccine– Patient Teaching
• Rho Immune Globulin– Criteria– Administration of Rhogam
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Discharge
• Instructions for Mother & Infant Care• Next Appointment• Referrals
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